PhDr. Mária SováriováSoósová, PhD.

PhDr. Mária Sováriová Soósová, PhD.

Training for Students1. – 15. September 2019, UPJŠ, Košice, Slovakia

Vital signs

Pulse

Respiratory rate

Body temperature

Blood pressure

PULSE

Definition

The pulse is a pressure wave that is transmitted through arterial tree with each heart beat following the expansion and recoil of arteries during each cardiac cycle (Marieb, Hoehn 2007).

The rhythmical throbbing of arteries produced by the regular contractions of the heart

the rhythmic contraction and expansion of an artery at each beat of the heart

Pulse

Indications

To gather information on the heart rate,

pattern of beats (rhythm) and apmlitude

(strenght) of pulse.

To determine the individual´s pulse on

admission as a base for comparing future

measurements.

To monitor changes of pulse.

(Marieb, Hoehn 2007).

Pulse

Conditions where a patient´s pulse may

need careful monitoring:

Postoperative, critically ill patients

Invasive procedure (Blood transfusion)

Local or systemic infections, inflammations

(sepsis)

Cardiovascular conditions

...

Pulse

Areas to take

the pulse

a location

where an artery

crosses a bony

area.

http://www.medtrng.com/cls/lesson_18.htm

FACIAL

Pulse

Assessment

Rate (frequency) per minute

Rhythm

Amplitude (strenght, quality)

Pulse rate – the number of beats

per minute (bpm)

Age Approximate range Approximate average

Newborn 120 – 160 140

1 – 12 months 80 – 140 120

12 months – 2 years 80 - 130 110

2 – 6 years 75 - 120 100

6 – 12 years 75 - 110 95

Adolescent, adults 60 - 90 80

Normal pulse rates at rest per minute at various ages

Dingová et al., 2011, p. 93

Pulse rates

Newborns 0 - 1 month old: 70 - 190 beats per minute

Infants 1 - 11 months old: 80 - 160 beats per minute

Children 1 - 2 years old: 80 - 130 beats per minute

Children 3 - 4 years old: 80 - 120 beats per minute

Children 5 - 6 years old: 75 - 115 beats per minute

Children 7 - 9 years old: 70 - 110 beats per minute

Children 10 years and older, and adults (including seniors): 60 - 100 beats per minute

Well-trained athletes: 40 - 60 beats per minute

Normal pulse rates at rest per minute at various ages according to U.S.

Department of Health and Human Services - National Institutes of

Health Pulse

Pulse rate – abnormal findings

Tachycardia an abnormally fast heart rate;

over 100 beats/min in adults(Marieb, Hoehn 2007).

this may result from:○ increased sympathetic response

due to physiccal/emotional stress

○ pregnancy

○ sepsis, fever, anemia, hypoxia, dehydratation, hemorrhage, shock, hyperthyroidism, cardiomyopathy, valvular heartdiseases, acute radiationsyndrome

○ some drugs,

○ ...

Bradycardia› an abnormally slow heart rate;

slower than 60 beats/min in adults (Marieb, Hoehn 2007).

› this may result from:

rest, sleep,

a low body temperature, hypothermia,

parasypathetic nervoussystem activation

decreased thyroid activity, hyperkalemia, an irregular cardiac rhythm,

drugs (digoxin)

... ...

Pulse - rhythm

Rhythm is the sequence of beats.

Regular (pulsus regularis)

results from coordinated contractions of the heart

sinus rhythm

Irregular (pulsus irregularis) – arrhythmias

results from uncoordinated contractions of the

heart

○ Fibrilation: rapid, irregular contractions

Pulse - strenght

Is a reflexion of pulse strenght and theelasticity of the arterial wall A bounding pulse is one that is easily detected

due to the exceptionally large amount of blood being pumped with each heartbeat.

A normal, regular pulse is easy to feel and has even beats of good force.

A weak pulse is difficult to detect due to a decreased amount of blood flowing through the arteries, usually due to bleeding or shock.

An absent pulse cannot be detected. Lack of a detectable pulse may indicate that the artery is blocked or injured.

Pulse amplitude abnormalitiesPulse amplitude Characteristics Conditions

Pulsus magnus a large, full pulse arterial

hypertension

Pulsus parvus et

tardus

a weak/small pulse and very slow,

late, that rises and falls gradually

aortis stenosis

Pulsus alternans alternation of large and small waves left ventricular

dysfunction

Pulsus duris a hard pulse aterosclerosis

Pulsus mollis a soft, easily compressible pulse hypotension

Pulsus filiformis a thready pulse, thin as a thread,

difficult to detect, usually very fast

bleeding, shock

...

Stedman's Medical Dictionary. Copyright © 2006 Lippincott Williams & Wilkins.

Radial pulse measurement

Wash hands

Collect equipment (wrist watch with second

hand, pen, piece of paper/documentation)

Explain procedure

Position patient

Place 3 fingers along appropriate artery

Apply light pressure on -//-

Count pulse 60 s.

Record the PR on documentation

Dougherty, L., Lister, S. 2008; Dingová, M. et al. 2011

Contraindications

Generally no

Relative:

Local injury, infllamation, infection, ...

A-V fistula,

...

Assessing apical pulse rate

Apical PR s the most reliable noninvasiveway to assess cardiac function.

Each pulsation is a combination of two sounds, S1 and S2.

Indication – the preferred method in: critically ill,

a history of heart-related health problems,

cardiovascular medications.

Auscultation position for apical

pulse rate

5th intercostal space

midclavicular line

(point for maximal

impulse PMI) for:

- apical pulse,

- mitral valve .

Assessing apical pulse rate

Wash hands

Collect equipment (stethoscope, wrist watch

with second hand, pen, paper, alcohol swab)

Explaine procedure

Position patient

Provide privacy

Count the apical pulse rate while the patient is at rest.

If the patient has been active, wait at least 5 to 10 minutes beforebeginning.

Disinfect earpieces and diaphragm of stethoscope.

Place the diaphragm of your stethoscope over the PMI andauscultate for normal S1 and S2 heart sounds. You will usuallyhear them as "lub-dub." If the apical pulse is regular, count for 30seconds, then multiply that number by 2. If the apical pulse isirregular or the patient is taking cardiovascular medications, countfor 1 full minute to ensure an accurate measurement.

Record the APR on documentation

Bibliography

Dingová, M. et al. Basics of Nursing. Textbook for medical and nursing

students. Martin: Comenius University in Bratislava, Jessenius Faculty of

Medicine in Martin, 2011.

Dougherty, L., Lister, S. The Royal Mardsen Hospital Manual of Clinical

Nursing Procedures. U.K. : Wiley & Blackwell, 2008.

Marieb, E.M., Hoehn, K. Human anatomy and physiology. Pearson Benjamin

Cummings, San Francisco, 2007.

Basal heart rate

The basal or resting heart rate (HRrest)

is measured while the subject is:

relaxed but awake, in a neutrally temperate

environment,

without stress, surprise.

Maximum heart rate

HRmax is the highest heart rate an individual can achieve without severe problems through exercise stress, and depends on age.

Formulas:

220 – age

220 – (0.9 * age) for women

220 – (0.8 * age) for men

Tanaka, Monahan, & Seals (2001) "Age-predicted maximal heart rate

revisited". Journal of the American College of Cardiology 37 (1): 153–6.

Optimal heart rate The best heart rate to burn body fat during

exercise = optimal heart rate = 60% to 80%(85) of maximum heart rate.

Age-Adjusted Method Lower limits for training:

HRopt = 0.60 * HRmax

= 0.60 * (220 – age)

= 0.60 * 220 – (0.9 * age) W

= 0.60 * 220 – (0.8 * age) M

Upper limits

HRopt = 0.80 * HRmax

= 0.80 * (220 – age)

The Karvonen Formula

for HRopt.

Target Heart Rate

= ((max HR − resting HR) × %Intensity)

+ resting HR example